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PACIF members: please report all claims as soon as possible. The sooner PACIF's claims representatives get involved, the more effectively we can apply our resources and the more quickly the claim can be processed.

Call 800-649-7915 immediately for claims involving death, serious injury, large-scale damage, or high-stakes liability. If appropriate, follow the instructions for filing a claim after office hours. In other cases, please use the correct online form, typing full descriptions in the form and attaching any related files.

All required information in the forms has been marked with a red asterisk. Forms will not process without all required information, so please complete forms carefully.

First Report of Injury
Workers' Compensation, for employees who experience a work-related injury or illness.

By state law, employers must report within 72 hours of learning of a work-related injury or illness — sooner is better.
Late reporting can develop into significant long-term costs.

  • The ill or injured employee should not fill in this form: the municipality's PACIF contact or other designated administrative staff member should do it with information from the employee's manager or supervisor.
  • If possible, before an employee seeks medical attention, the supervisor should print and sign a Workers' Comp "First Fill" prescription form and give it to the employee. Then if the medical provider prescribes a medication right away, the employee can have it filled at a participating pharmacy without paying for it out of pocket.

Auto Loss Notice
For damage to or caused by a municipally-owned road vehicle, including heavy equipment and fire trucks.

Please type complete information and descriptions into the form (even if the information is also in a file that you will attach).

General Liability Loss Notice
For loss or potential loss due to slips/trips/falls by members of the public, sewer/water breaks, errors and omissions, lawsuits, employment practices, etc.

Please type complete information and descriptions into the form (even if the information is also in a file that you will attach).

Municipal Property Loss Notice
For damage to or loss of property including buildings and contents, mobile or portable equipment, and other property, through various means including theft and fraud.

Please type complete information and descriptions into the form (even if the information is also in a file that you will attach).

Note: the First Report of Injury must always be filed online.

Fillable PDF forms for Auto, Liability, and Property Loss Notices are still available for you to download at your convenience, so you have them available as a backup in case your internet access fails. If necessary, you can complete forms offline and either fax or mail them in for processing.

Fax: (802) 229-2211 Attn: Claims

Mailing address:

VLCT PACIF – Claims Division
89 Main Street, Suite 4
Montpelier, VT 05602

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